Pape Britta, Thiessen Pernille Staal, Jakobsen Flemming, Hansen Torben Baek
Regional Hospital Holstebro, The Lundbeck Center for Fast Track Hip and Knee Surgery , Denmark .
J Interprof Care. 2013 Nov;27(6):496-500. doi: 10.3109/13561820.2013.808611. Epub 2013 Jun 27.
Fast-track hip and knee surgery focuses on optimising pain management, achieving early mobilisation and shortening the length of stay in hospital. These factors make interprofessional collaboration imperative. With the aim of further diminishing the length of stay for patients admitted to an orthopaedic ward for hip or knee replacement and with inspiration from an interprofessional training unit, a daily interprofessional meeting was introduced. At this interprofessional meeting, surgeons, nurses, occupational therapists and physiotherapists used a checklist in discussing barriers and focus areas for discharging hip and knee replacement patients and made joint decisions about which healthcare profession should handle a given task. This interprofessional collaboration was tested in a case control study comparing hospital length of stay in 75 patients treated before introduction of the daily interprofessional meeting with 88 patients treated after the introduction. The result was a significant reduction in the length of stay in hospital in total hip replacement patients (from a mean of 4.1 days (SD 2.1) to 2.7 days (SD 1.4), p < 0.05) but not in knee replacement patients (from a mean of 3.7 days (SD 1.9) to 3.1 days (SD 1.6), p = 0.33). So improving interprofessional collaboration by introducing an interprofessional daily meeting may reduce the length of stay in hospital for total hip replacement patients, but further studies are needed to explore the effect in knee replacement patients.
快速康复髋关节和膝关节手术的重点是优化疼痛管理、实现早期活动并缩短住院时间。这些因素使得跨专业协作势在必行。为了进一步缩短因髋关节或膝关节置换入住骨科病房患者的住院时间,并受一个跨专业培训单元的启发,引入了每日跨专业会议。在这个跨专业会议上,外科医生、护士、职业治疗师和物理治疗师使用一份清单来讨论髋关节和膝关节置换患者出院的障碍和重点领域,并就应由哪个医疗专业处理特定任务做出共同决定。这种跨专业协作在一项病例对照研究中进行了测试,该研究比较了在引入每日跨专业会议之前治疗的75例患者与引入之后治疗的88例患者的住院时间。结果是全髋关节置换患者的住院时间显著缩短(从平均4.1天(标准差2.1)降至2.7天(标准差1.4),p < 0.05),但膝关节置换患者的住院时间没有显著缩短(从平均3.7天(标准差1.9)降至3.1天(标准差1.6),p = 0.33)。因此,通过引入每日跨专业会议来改善跨专业协作可能会缩短全髋关节置换患者的住院时间,但需要进一步研究来探讨其对膝关节置换患者的影响。